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Bacterial Profile and Antibiotic Susceptibility Pattern of Patients at Pre- and Post-Urologic Endoscopy Procedures at Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia Paulus Oroh; Ari Astram; Christof Toreh; Eko Arianto; Frendy Wihono; Windy Wariki; Hessyani Raranta
e-CliniC Vol. 11 No. 1 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i1.44315

Abstract: Development of antibiotics resistance condition has been at a concerning state while data on the distribution of bacterial profile and the incidence of resistances in Indonesia are currently still limited at hospital environment, including at Prof. Dr. R. D. Kandou Hospital in Manado, Indonesia. This study aimed to obtain the profile of bacteria and the pattern of susceptibility to antibiotics in patient's urine before and after urologic endoscopy procedures at RSUP Prof. Dr. R. D. Kandou. This was an observational study with a cross sectional design. Sampling was performed with the one-group test technique of Lemeshow. The data collection technique used urine culture test by calculating the percentages. The results obtained 42 patients as subjects. The urinary bacterial profile of patients who underwent urologic endoscopy procedures at Prof. Dr. R. D. Kandou Hospital were dominated by Gram-negative bacteria, namely E. coli (23.8%), Klebsiella (4.8%), Acinetobacter baumannii (2.4%); 69% of urine samples showed negative culture results. The susceptibility pattern of bacteria to antibiotics in the subjects’ urine showed 100% sensitivity to the given antibiotics. No nosocomial infection was found, however, nosocomial infection yet could not be excluded. In conclusion, bacteria found in the patients’ urine are dominated by Gram-negative bacteria namely Escherichia coli, Klebsiella, and Acinetobacter baumannii which are still sensitive to antibiotics. Most urine samples showed negative results, and no nosocomial infection was found. Keywords: bacterial profile; bacterial susceptibility; antibiotic; urological endoscopic procedure

Transurethral Vaporization of Bladder Neck Using Holmium Laser: First Experience in Manado Mahesa Krishna; Eko Arianto; Ari Astram; Frendy Wihono; Christof Toreh
Medical Scope Journal Vol. 6 No. 1 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i1.46491

Abstract: Bladder neck contracture (BNC) is a potential complication after radical prostatectomy (RP). This may be a result of inadequate approximation at the time of surgery, urinary extravasation, or distraction of the bladder neck from a hematoma. Patients commonly complains of a poor urinary stream or prolonged unexplained incontinence. Treatment of BNC requires a tailored approach and can range from simple, office-based procedures to complex surgical reconstruction. We reported a case of 81-year-old male complaining urine retention for one month. The patient had previous open prostate procedure a year prior. On examination, neurogenic causes were excluded. Retrograde ureterocystography revealed bladder neck contracture. Patient was diagnosed as bladder neck contracture post open prostatectomy surgery. Transurethral holmium laser vaporization with 800 micrometre, 20 Hz frequency and 4,5 Joule of power. through a ureteroscope was performed. Two-way Folley catheter 18Fr was inserted without irrigation. Patient was discharged post-surgery two days after catheter removal and spontaneous micturition. Endoscopic balloon dilatation with incision appears to offers promising result in the management of BNC. The consideration of using transurethral vaporization with holmium laser modality was the first procedure ever done in Manado. In conclusion, TUVP is one of the alternatives, minimally invasive procedures to treat BNC. The use of holmium laser for the incision of bladder neck is another alternative to treat BNC with great outome proven by the length of stay (LOS) of two days after the procedure was done. Keywords: bladder neck contracture; transurethral vaporization; holmium laser; post prostatectomy

Karakteristik Pasien Operasi Rekonstruksi Hipospadia yang Menjalani Terapi Oksigen Hiperbarik di RSUP Prof. Dr. R. D. Kandou dan RS Siloam Manado Irawan Sukarno; Ari Astram; Mendy J. Hatibie; Fredrik G. Langi
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.46457

Abstract: Hypospadias is a congenital abnormality of urethral meatus in male. Hypospadias can be corrected by urethroplasty. Hyperbaric oxygen therapy (HBOT) can accelerate wound healing after surgery by increasing oxygenation, angiogenesis, and collagen synthesis. This study aimed to describe the characteristics of hypospadias reconstructive surgery patients who underwent hyperbaric oxygen therapy. This was a quantitative and descriptive study. Data were analyzed with SPSS ver 22.0. The results showed that from 20 patients who underwent reconstructive hypospadias surgery, 10 patients received HBOT as adjuvant therapy and 10 patients received conservative therapy post-surgery. The mean age of patients who underwent HBOT was 17.4±7.1 years old. The most frequent type of hypospadias found was subcoronal (35%), followed by the other types: glandular (20%), distal penile (10%), midshaft penile (10%), proximal penile (10%), penoscrotal (10%), and the least was scrotal (5%). All of the patients underwent urethroplasty with Sidik-Chaula and Manset Flap method. In conclusion, the mean age of patients who underwent HBOT was 17.4±7.1 years old, and the most frequent type of hypospadias found was subcoronal. Keywords: hypospadias; hyperbaric oxygen therapy; characteristics of hypospadias patients Abstrak: Hipospadia merupakan kelainan kongenital meatus uretra pada laki-laki. Hipospadia dapat dikoreksi dengan uretroplasti. Terapi oksigen hiperbarik (TOHB) dapat mempercepat penyembuhan luka pascaoperasi melalui peningkatan oksigenasi, angiogenesis, dan sintesis kolagen. Penelitian ini bertujuan untuk mengetahui karakteristik pasien rekonstruksi hipospadia yang menjalani TOHB. Jenis penelitian ialah deskriptif kuantitatif dengan alat analisis SPSS ver. 22.0. Hasil penelitian mendapatkan 20 pasien yang dilakukan operasi rekonstruksi hipospadia; 10 pasien menjalani TOHB dan 10 pasien menjalani terapi konservatif pasca pembedahan. Rerata usia pasien yang menjalani TOHB yaitu 17,4±7,1 tahun. Tipe hipospadia yang paling sering ialah subcoronal (35%), diikuti tipe glandular (20%), dan sisanya ialah tipe distal penile (10%), midshaft penile (10%), proximal penile (10%), penoscrotal (10%), dan yang paling sedikit ialah tipe scrotal (5%). Semua pasien menjalani operasi dengan metode Sidik-Chaula dan Manset Flap. Simpulan penelitian ini ialah rerata usia pasien yang menjalani TOHB ialah 17,4±7,1 tahun dengan tipe hipospadia yang paling sering ialah subcoronal. Kata kunci: hipospadia; terapi oksigen hiperbarik; karakteristik pasien hipospadia

Penentuan Model Prediktif Metastasis Tulang dan Prognosis Kanker Prostat Menggunakan Alkalin Fosfatase dan Skor Gleason Marcella Merung; Christof Toreh; Ari Astram; Fredrik G. Langi
Medical Scope Journal Vol. 6 No. 1 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i1.48491

Abstract: To date, assessment of the prognostic ability based on the relationship between alkaline phosphatase (ALP) to the Gleason score has not been reported. This study aimed to compare ALP with Gleason score as a predictor of prostate cancer prognosis. This was a hospital-based cross sectional study conducted from January 1, 2019 to December 31, 2021. Prostate cancer patient information included demographics, disease history, clinical characteristics, laboratory and radiology tests, and histopathology results. The results showed that the majority had a poor degree of differentiation (Gleason score: 8-10), which was 85.5%. High serum prostate specific antigen (PSA) levels were associated with the scores. The results of ALP were normal in 59.4%, increased in 34.4%, and decreased in 6.3% of patients. The multivariate regression analysis showed that every 10 U/L increase in ALP in the blood of prostate cancer patients on average was associated with a worse prognosis characterized by an increase in Gleason score of about 0.06 points (95% CI 0.03-0.09; p=0.002). In conclusion, serum alkaline phosphatase can be a predictive factor of bone metastases in prostate cancer with a cut value of 102 IU/L. Each increase of 10 IU/L of serum ALP is associated with a worse prognosis in prostate cancer while the Gleason score cannot be a predictive indicator of bone metastases in prostate cancer. Keywords: alkaline phosphatase; prostate specific antigen; Gleason score; prognostic predictor Abstrak: Penilaian kemampuan prognostik kanker prostat berdasarkan hubungan alkalin fosfatase (ALP) dengan skor Gleason sampai saat ini belum pernah dilaporkan. Tujuan penelitian ini untuk membandingkan kadar ALP dengan skor Gleason sebagai prediktor prognosis kanker prostat. Penelitian ini menerapkan desain potong lintang berbasis rumah sakit dari 1 Januari 2019 hingga 31 Desember 2021. Informasi pasien kanker prostat mencakup demografik, riwayat penyakit, karakteristik klinik, hasil pemeriksaan laboratorium dan radiologi, serta data histopatologi. Hasil penelitian memperlihatkan proporsi terbesar memiliki tingkat diferensiasi buruk dengan skor Gleason: 8-10 sebesar 85,5%. Data tingginya kadar prostate specific antigen (PSA) serum berhubungan dengan skor Gleason. Pada penelitian ini ALP dengan hasil normal 59,4%, meningkat 34,4%, menurun 6,3%. Hasil analisis regresi multivariat menunjukkan setiap 10 U/L kenaikan ALP dalam darah pasien kanker prostat rata-rata berhubungan dengan prognosis lebih buruk ditandai oleh peningkatan skor Gleason sekitar 0,06 poin (95% CI 0,03-0,09; p=0,002). Simpulan penelitian ini ialah ALP dapat menjadi faktor prediksi metastase tulang pada kanker prostat dengan nilai potong 102 IU/L. Setiap peningkatan 10 IU/L ALP serum berhubungan dengan prognosis yang lebih buruk pada kanker prostat sedangkan skor Gleason tidak dapat menjadi indikator prediksi metastase tulang pada kanker prostat. Kata kunci: alkaline fosfatase; prostate specific antigen; skor Gleason; prediktor prognosis

The Importance of Preoperative Evaluation to Predict the Outcome of Percutaneous Nephrostomy Ronald J. Datu; Eko Arianto; Ari Astram; Christof Toreh
Medical Scope Journal Vol. 6 No. 2 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i2.52858

Abstract: Percutaneous nephrostomy (PCN) is an invasive procedure equal to a grade 4 penetrating kidney trauma. It should be carefully considered whether has a greater benefit or risk. There are currently no parameters or scores to predict the outcome of nephrostomy in our center. This study aimed to conduct a review to find out whether there were parameters or scores that could be used to predict the outcome of nephrostomy. This research used relevant studies obtained from Clinical Key, PubMed, Semantic Scholar, Dimensions, and Science Direct published in the last 10 years and written in English. Studies on children and transplant cases were excluded. Studies that met the PICO criteria were selected. The results showed that of the 141 articles collected, and filtered with inclusion criteria, exclusion criteria, and PICO criteria, finally the remaining were three studies selected. The studies discussed about classification, SFU grading system, and complication of nephrostomy; significant variables affecting recoverability of renal function; patients’ characteristics and outcomes of double J ureteral stenting (DJS) and PCN; and 12-month-post-operative creatinine level change. Most patients who failed DJS had increased creatinine level. However, one of the indications for a nephrostomy was stenting failure. In conclusion, predictor factors that can affect the renal recovery after nephrostomy include kidney shape and size, pre-nephrostomy creatinine levels, urine output, state of infection, and degree of hydronephrosis. However, the evidence is still not enough. Further research is needed on the predictor factors for renal recovery after nephrostomy. Keywords: percutaneous nephrostomy; hydronephrosis; kidney function; predictors

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